Julia Murlewska, Maciej Słodki, Roland Axt-Fliender, Giusseppe Rizzo, Mark Sklansky, Stuart Weiner, Isaac Blickstein and Maria Respondek-Liberska
1. Sklansky M.S. Current guidelines for fetal echocardiography: time to raise the bar. J Ultrasound Med. 2011; 30: 284-286.
2. Nelle M, Raio L, Pavlovic M, Carrel T, Surbek D, Meyer-Wittkopf M. Prenatal diagnosis and treatment planning of congenital heart defects-possibilities and limits. World J Pediatr. 2009; 5: 18-22.
3. Słodki M., Zych-Krekora K., Axt-Fliedner R., [et al.]. The International PrenatalCardiology Collaboration Group- a new concept for global research study. Journal of
Introduction: The majority of research regarding echogenic intracardiac focus (EIF) concentrates on its weak correlation with the occurrence of Down syndrome. The aim of our research was to approach this problem from a wider perspective and to find out, if the prenatal diagnosis of EIF is connected with the occurrence of other abnormalities of prenatal and postnatal period.
Materials & Methods: The data of 114 patients with prenatally diagnosed EIF were analyzed retrospectively. No fetal or neonatal chromosomal abnormalities were included.
Results: In 13/114 (11,4%) fetuses cardiological abnormalities other then EIF were diagnosed: 8/114 (7%) cases of congenital heart defects and 7/114 (6,1%) cases of tricuspid valve regurgitation. Extracardiac malformations were diagnosed in 11/114 (8,8%) of fetuses. In 7/114 (6,1%) of the cases the abnormal volume of amniotic fluid was diagnosed. In 4/114 (3,5%) of pregnancies the premature rapture of membranes (PROM) occurred. Six, 6/114 (5,3%) of pregnancies were at risk of intrauterine asphyxia in perinatal period. 12/114 (10,5%) newborns were delivered before 37th week of gestation, stillbirth occurred in 1/114 (0,9%) case. Most newborns (86/114; 75,4%) birth weight >3000g. In 19/114 (16,7%) of newborns birth weight was 2500g-3000g. In 9/114 (7,9%) of newborns birth weight was <2500g
Conclusions: Fetuses with EIF without chromosomal aberrations may present heart defects which are hard to diagnose in basic obstetrical USG scan. Therefore, those patients should be directed to prenatal cardiology facilities for evaluation of the fetal heart.
Prenatal EIF in fetuses without chromosomal aberrations may indicate low birth weight (<2500g) in the future. Further research of this matter is needed.
fetal heart examination form granted by Polish Ministry of Health Program Kardio-Prenatal 2008]. Ginekol Pol. 2009 Jun;80(6):466-70.
20. Respondek-Liberska, M. Sklansky, M. Wood, D. et al. Recommendations for Fetal Echocardiography in Singleton Pregnancy in 2015. PrenatalCardiology 2015; 5(2): 28-34.
21. Strzelecka, I. Płużańska, J. Węgrzynowski, J. et al. Routine third trimester fetal cardiac evaluation: time for consideration. PrenatalCardiology 2015; 5(3): 18-23.
22. Franklin O., Burch M., Manning N., Sleeman K
-Liberska M, J Dangel, A Włoch. 2006. “Certificate of Fetal Heart Screening (basic level) Section of Prenatal Echocardiography and PrenatalCardiology of the Polish Ultrasound Society”. Ultrasonografia 25: 82-86
6. Respondek-Liberska M, J Dangel, A Włoch. 2006. “Certificate of Fetal Heart Echocardiography examination (an advanced level) Section of Prenatal Echocardiography and PrenatalCardiology of the Polish Ultrasound Society”. Ultrasonografia 25: 87-90
7. Pruetz JD, C Carroll, LU Trento et al. 2014. “Outcomes of critical congenital heart
Paulina Kordjalik, Beata Radzymińska-Chruściel, Maciej Słodki, Agata Włoch, Joanna Szymkiewicz-Dangel, Maria Respondek-Liberska and Zdzisław Tobota
. Respondek-Liberska M, Dangel J, Włoch A.: Certificate of Fetal Heart Screening (Basic level) Section of Prenatal Echocardiography and PrenatalCardiology of the Polish Ultrasound Society. Ultrasonografia 2006, 25: 82-86
12. Respondek-Liberska M, Dangel J, Włoch A.: Certificate of Fetal Heart Echocardiography examination (an advanced level) Section of Prenatal Echocardiography and PrenatalCardiology of the Polish Ultrasound Society. Ultrasonografia 2006, 25: 87-90
13. Słodki M, Dangel J, Respondek-Liberska M.: The National Registry for
Maria Respondek-Liberska, Mark Sklansky, Dennis Wood, Maciej Słodki, Stuart Weiner, Bettina Cuneo, James C. Huhta, Ulli Gembruch, Giuseppe Rizzo, Gurleen Sharland, Reuven Achiron and Jay D. Pruetz
3. Allan L, Dangel J, Fesslova V, Marek J, Mellander M, Oberhänsli I, Oberhoffer R, Sharland G, Simpson J, Sonesson SE.: Fetal Cardiology Working Group; Association for European Paediatric Cardiology. Recommendations for the practice of fetal cardiology in Europe. Cardiol Young. 2004,14:109-14
4. Respondek-Liberska M, Dangel J, Włoch A.: Certyficate for Basic Fetal Heart Evaluation Section of Echocardiography and PrenatalCardiology Polish Ultrasound, Ultrasonografia 2006, 25:82-86
5. Respondek-Liberska M, Dangel J, Włoch A
Paulina Kordjalik, Zdzisław Tobota and Maria Respondek-Liberska
classification of congenital heart disease. Prenat Diagn. 2015; 35: 620-1.
9. Słodki, M, Respondek-Liberska M. "Hypoplastic Left Heart Syndrome at the Tertiary Fetal Cardiac Center: As Planned, Urgent or Severest Congenital Heart Disease? Prenatal Classification for Obstetricians and Neonatologists" PrenatalCardiology 2016, Jan 3(4); 2016; 3: 23-27.
10. Słodki M, Respondek-Liberska M. Proposal of screening fetal heart examination form granted by Polish Ministry of Health Program Kardio-Prenatal 2008. Ginekol Pol. 2009; 80: 466
Iwona Strzelecka, Maciej Słodki, Katarzyna Zych-Krekora, Michał Krekora, Mariusz Grzesiak, Iwona Maroszyńska and Maria Respondek-Liberska
1. Słodki M, Zych-Krekora K, Axt-Fliedner R, Bianchi A, Araujo E Jr, Blickstein I, Kelekci S, Yeo L, Pruetz JD, Rizzo G, Seligman N, Sklansky M, Catte L, Weiner S, Chervenak F, Cruz J, Kurkevych A, Krekora M, Respondek-Liberska M. The International PrenatalCardiology
2. Collaboration Group - a new concept for global research study. J Ultrasonog. 2016; 16: 94-96.
3. Van Velzen CL, Türkeri F, Pajkrt E, Clur SA, Rijlaarsdam ME, Bax CJ, Hruda J, de Groot CJ, Blom NA, Haak MC. Pregnancy complications in
Maria Respondek-Liberska, Maciej Łukaszewski, Adam Oleś, Michał Podgórski, Piotr Grzelak and Maciej Słodki
Introduction: Fetal echocardiography is a method of choice for diagnosing cardiovascular anomalies prenatally. However, in the majority of cases, the complexity of a defect creates a diagnostic challenge. Moreover, postnatal validation of sonographic findings rarely can be obtained. Nevertheless, the feedback is vital for improving diagnostic capabilities. Thus, the aim of this research was to compare results of prenatal echocardiography with postnatal angio-CT in patients with anomalies of great vessels. Material and methods: We retrospectively compared results of prenatal echocardiography and postnatal angio-CT in 10 patients with selected anomalies of the aortic arch. This was a qualitative analysis, thus discrepancies in recognized anomalies were compared between these two modalities. Results: In 8/10 patient diagnoses were fully consistent. Nevertheless, the tiny caliber of vessels created a diagnostic challenge (e.x. to differentiate the hypoplastic aortic arch from the aortic arch interruption). In the remaining case, the discrepancy was due to a problem with complete visualization of all branches of the aortic arch in prenatal ultrasound. Conclusions: Fetal echocardiography in tertiary center was a reliable method for assessment of great vessels anomalies. However, critically narrow vessels remain a diagnostic challenge and neonatal angio-CT seems to be the method of choice in cases of diagnostic doubts.
Michał Krekora, Mariusz Grzesiak, Maciej Słodki, Ewa Gulczyńska, Iwona Maroszyńska, Maria Respondek-Liberska, Frank A. Chervenak and Laurence B. McCullough
INTRODUCTION: The aim of this study was to present our current practice of counseling patients and families with the most severe congenital malformations in the 3rd trimester of pregnancy and to develop practical guidelines for our team and involved healthcare/ socialcare professionals. MATERIAL & METHODS: It was a retrospective evaluation of a series of fetal cases in 2017 from single tertiary center. Maternal obstetrical medical history, time of prenatal detection of the anomaly (1st, 2nd or 3rd trimester), time between last fetal echocardiography and delivery, type of delivery, neonatal birth weight and time of neonatal demise. The total study group was subdived into early demise (during the 1st day after delivery) or late demise > 1st day after delivery. RESULTS: Mean maternal age was 30,4 +/- 5,6 years, and varied between 26 and 38 years. No chronic maternal diseases were found in medical history and no congenital malformations were present in previous children. All women had 1st trimester ultrasound, in 9 cases, it was reported as normal (with NT measurement < 2 mm), in 2 cases extracardiac abnormalities were detected: diaphragmatic hernia and omphalocele ( in both fetal karyotype 46,XY). In nine cases, the abnormalities were detected in midgestation and with maternal wish to continue the pregnancies. There were 8 neonatal deaths within 60 minutes after delivery, including one intrapartum death and 3 “late” neonatal deaths in the intensive care unit (on 12th, 21st and 22nd day). We stress upon the prenatal team approach and counseling of future parents, in order to prepare them for poor neonatal outcome. CONCLUSIONS: 1. In the most severe cases when fetal or neonatal demise was suspected, the two different opinions of specialists might not be enough and a third opinion should be recommended before final decision. 2. A Fetal Team of specialists is necessary in cases of expected fetal/neonatal demise in order to prepare a written report of recommended perinatal management for all sides involved in this difficult problem.